Retrospective Comparisons about Effects of Angiotensin II Receptor Blocker and/or Steroid on Proteinuria Reduction and Renal Protection in IgA Nephropathy Patients with Proteinuria less than 1 g/g / 대한신장학회지

PURPOSE: It remains controversial how to treat the IgA nephropathy (IgAN) patients with proteinuria <1g/day. We investigated effects of single or combined use of angiotensin II receptor blocker (ARB) and steroid on proteinuria reduction and renal protection in IgAN patients with normal renal function and urine protein/creatinine ratio (PCR) < or =1 g/g. METHODS: Oral prednisolone was given at an initial dose of 1 mg/kg every day for 2 months and then gradually tapered for 4 months. An ARB irbesartan or losartan or valsartan was given until the end of follow-up. RESULTS: Over a mean follow-up period of about 40 mo, the urine PCR decreased from 0.64+/-0.29 g/g to 0.32+/-0.31 g/g in the combination group (n=26) (p<0.05). But in ARB (n=17) and steroid groups (n=20), it decreased from 0.56+/-0.26 g/g to 0.54+/-0.45 g/g and from 0.50+/-0.26 g/g to 0.34+/-0.32 g/g, respectively, while there were no statistical significances. Serum creatinine decreased from 0.83+/-0.13 mg/dL to 0.73+/-0.14 mg/dL in steroid group (p<0.01), and from 0.92+/-0.17 mg/dL to 0.81+/-0.23 mg/dL in combination group (p<0.01). But in ARB group, no statistical significance was noticed. All patients achieved the BP goal < or =130/80 mmHg by adding anti-hypertensive drugs, if necessary. CONCLUSION: Our results indicate that (steroid or) combination therapy reduced proteinuria and improved renal function in the patients with proteinuria < or =1 g/g. Further prospective controlled studies are required to clarify the effect of steroid over the long term.

The Effect of Conversion from Cyclosporine to Tacrolimus in Renal Allograft Recipient with Hyperlipidemia / 대한신장학회지

PURPOSE: Management of cardiovascular risk factors is of major importance in renal transplant recipients to determine long-term outcomes. While calcineurin inhibitors improve the clinical course after kidney transplantation, they have been implicated in contributing to increased cardiovascular risk. This study investigated the influence of conversion from cyclosporine to tacrolimus on cardiovascular risks and graft function in renal allograft recipients with hyperlipidemia. METHODS: Twenty three adult renal recipients who were receiving cyclosporine-based regimen for more than one year after transplantation and had hyperlipidemia (serum total cholesterol > or =200 mg/dL) were enrolled. The effect of conversion from cyclosporine to tacrolimus was evaluated with blood pressure, fasting lipid profile, glucose and HbA1c. They were measured at baseline and at 1, 3, 6 and 12 months after conversion. The change in estimated glomerular filtration rate (eGRF) was also compared between before and after conversion. RESULTS: Though conversion from cyclosporine to tacrolimus did not cause significant differences in the serum triglyceride level, there was a noticeable decline in total cholesterol level (213.78+/-16.28 to 185.96+/-38.62 mg/dL, p<0.01). Conversion did not trigger new onset or worsening of diabetes mellitus with no meaningful differences in fasting blood glucose and HbA1c levels. The eGFR stabilized with Tacrolimus in comparison with the cyclosporine (-2.9+/-13.4 mL/min vs. -7.3+/-13.8 mL/min). CONCLUSION: Conversion to tacrolimus would be preferable to cyclosporine for maintenance immunesuppression in renal recipient with hyperlipidemia, as it meliorates hyperlipidemia and leads to stabilization of allograft function.

Glucose Pump Technique is as Good as Ultrasound Dilution Technique for Vascular Access Surveillance in Hemodialysis Patients / 대한신장학회지

PURPOSE: Vascular access flow (Qa) measurements are important in the surveillance protocol of hemodialysis vascular access stenosis. The glucose pump technique (GPT) is a technique for Qa measurement based on the dilution technique of a constant glucose infusion that was introduced in 1995. The aim of this study is to verify the clinical efficacy of GPT in vascular access surveillance compared with ultrasound dilution technique. METHODS: In 31 chronic hemodialysis patients with a AV fistula, we compared Qa measurements performed with GPT in pre-dialysis and the ultrasound dilution technique (Transonic HD01, Transonic System Inc., Ithaca, NY) during hemodialysis. RESULTS: Mean Qa was 1171 ml/min by GPT versus 1028 ml/min by HD01 (p=0.262). There was a strong linear correlation between the two methods (r=0.61; p<0.01). Ultrasound dilution technique HD01 yielded 6 cases of high risk Qa measurements and GPT yielded 4 cases of high risk Qa measurements. The diagnostic accuracy of GPT tested with the ROC curve was similar with ultrasound dilution technique HD01. The specificity and sensitivity was 80% and 66.7% according to Qa=600 ml/min. But sensitivity was 83.3% according to Qa=750 ml/min. CONCLUSION: GPT offers the advantage of a simple and economic bedside procedure easily performed before dialysis and had a similar diagnostic accuracy and efficiency compared with ultrasound dilution technique HD01.